1. Targeted Case Management : Time Survey Coding
LGA Training: 2017

2. TIME SURVEY Time Survey
Perpetual tracking of time using TCM codes through AVATAR (San Mateo Family Health System Home Visiting Programs)
Track in 15 min increments
Make sure AVATAR matches ATKS (payroll system)
Track to Other Programs and Activities: 1915(c) client
Track to NA: Comp time used (ATKS 052)

3. Perpetual Time Survey Every work day Every paid hour
For those of you who do not do perpetual, you receive a PPL regarding when you time survey.
For 5 consecutive days of time survey you have 400 or more staff.
For 10 consecutive days of time survey you have 200 – 399 staff
For 20 consecutive days of time survey you have 199 – 100 staff

4. Who time surveys? Case managers Supervisors Support Staff
In the TCM identified budget unit:
Case managers
Supervisors
Support Staff
Case Managers in San Mateo County:
CPS – Community Program Specialist
SrCW – Senior Community Worker
CW – Community Worker
RD – Registered Dietitian
PHN – Public Health Nurse

5. What is the purpose of the TCM time survey?
To document the time spent on ALL activities related to the provision of Targeted Case Management.

6. What happens with the TCM Time Survey Results?
Your time survey determines the amount of time you are performing Targeted Case Management.

7. Correctly tracking your time allows you to maximize the revenues you can receive from this funding source
* (need more explanation)

8. How do I keep track of my activities?
Keep track of your time by the minute. At the end of the day add all your minutes up and round up or down to the nearest 15 minute increment.
So if you do 6 minutes of TCM, you would round down to zero. If you do 8 minutes of TCM you would round up to 15.
You can use your daily calendar as back up. You do not need to turn this in with your MAA time survey but must keep for the 5 year audit period.

9. Your time survey must be completed DAILY.
This is key! This will make time surveying more accurate and streamline process. Take the example before of “rolling up” time. This will be much more difficult if attempting to do at the end of the week. It is much easier to remember what you completed during the day at the end of day than trying to recall activities long after the face

10. 8 hours on timesheet = 8 hours on time survey
At the end of each day...
The total for that day on your time survey must be the same number you put on your timesheet.
Example:
8 hours on timesheet = 8 hours on time survey
The biggest error we find in comparing time sheets to time surveys is Paid Time Off on the timesheet not matching claimed Paid Time Off on the time survey

11. TCM Activity Codes
San Mateo County: Time Survey Category

12. TCM Activity Codes 24. Providing a TCM Service Component
25. TCM Encounter-Related Activities
26. Travel Related to Providing TCM
27. Supervision of Case Managers
30. TCM Quality Assurance/Performance Monitoring
32. TCM Program Planning & Policy Development
Specific codes are used by specific positions. You will not use every code. As I talk about the codes I will denote the types of positions that will be time surveying to each code. But as a quick overview. The 3 codes highlighted orange are used by case managers and CHWs. The 3 codes in gray are used by the supervisors of case managers. And 3 codes in black are used at a program level and are not applicable to either case managers or supervisors.
29. TCM Data Systems and Claiming Coordination
28. Encounter Entry into TCM On-Line System
31. TCM Subcontract Administration

13. 24. Providing TCM Service Components
TCM service components are defined as services furnished to assist individuals, eligible under a specific targeted population, to gain access to needed medical, social, educational, and other services.
This includes performing any one of the TCM service components:
Comprehensive assessment and periodic reassessment of the individual’s needs
Development (and periodic revision) of a specific care plan
Referral and related activities
Monitoring and follow-up activities
During a face-to-face encounter
This code is used by case managers and CHWs. This is all activities performed within a face-to-face encounter, since TCM service components can only be provided face to face.
San Mateo County: TCM – Service Component
Face-to-face visit with a Medi-Cal eligible client in the home, office or location other than home to provide assessment, screening, care plan development or reassessment, referrals, and linkages

14. 24. Providing TCM Service Components
Examples:
A case manager takes a client history during an office visit to develop a comprehensive assessment.
During a face-to-face visit a case manager provides a referral to a vocational training program to address an identified need in a client’s care plan.
A case manager follows up in person with a client about a referral to the food bank, an identified need in the client’s care plan.
A case manager calls to schedule an appointment for a client during a home visit.

15. 25. TCM Encounter-Related Activities
TCM Encounter-Related Activities include time spent performing tasks that directly support TCM face-to-face encounters.
Examples:
A case manager makes a telephone call to a client to perform a 30-day follow-up regarding a referral
A case manager completes and reviews documentation related to a client’s case
A CHW or case manager arranges and schedules an appointment for a client, while at the office
A CHW manages the intake and processing for TCM referrals
A case manager sits with their supervisor to review their documentation and time survey
A case manager consults with a physician regarding a client’s most recent visit
A case manager reviews case notes and gathers client information and materials prior to drafting a comprehensive assessment
Time spent trying to locate a TCM client at the Brookside Shelter
This code is used by case managers and CHWs. This is all the activities that support a face-to-face encounter.
TCM – Encounter Activity
Staff time contacting providers, family members, or others on behalf of a client or researching information on behalf of a client
Case manager is consultant to the primary case manager
Staff time spent by a case manager providing translation for services to a client at a face-to-face encounter or over the phone

16. 26. Travel Related to Providing TCM
Staff travel time to provide TCM services and any TCM related activities to a client.
This is for travel related to TCM services. If traveling to a client to provide direct patient care, the travel time would be coded to direct patient care.
This is not for client transportation.
Examples:
A case manager drives to a client’s home to conduct an initial needs assessment.
A case manager and CHW drive to the hospital to assist a TCM client with accessing services and follow-up on referrals provided.
A case manager travels to a client’s home to perform a 6-month re-assessment, but the client is not home.
This code is used by case managers and CHWs
If you do other services at the face-to-face TCM encounter, you must break out the travel time to the other program

17. 26. Travel Related to Providing TCM
What to do if time spent in a home visit is divided?
You need to allocate the driving time appropriately to the activities performed.
For example: A Case Manager travels 30 minutes to a client’s home.
The home visit lasts 1 hour. During the home visit half of the CM’s time was spent on providing TCM service components and the other half of her time was spent on direct patient care.

18. 27. Supervision of Case Managers
Supervision of case managers in the performance of TCM related services.
Examples:
A supervisor reviews a case manager’s charts to ensure appropriate actions are taken to meet the client’s goals and needs
A supervisor provides orientation for new case managers
A supervisor assigns new referrals to appropriate case managers
A supervisor meets with a case manager to review their documentation together
This code is for supervisors of case managers
This is for TCM services only, not for other services, not for general administration type of activities, such as evaluations

19. 30. TCM Quality Assurance & Performance Monitoring
TCM provider monitors Medi-Cal services providers to insure quality, capacity, and availability of services.
Examples:
A TCM provider develops and maintains a TCM Performance Monitoring Plan to prevent countywide duplication of services.
A case manager supervisor reviews TCM case documentation to make sure it is in compliance.
Reviewing and signing charts

20. 32. TCM Program Planning and Policy Development
Medi-Cal and Non-Medi-Cal clients includes time spent developing strategies to increase TCM services to capacity and close gaps in resources.
Examples:
Supervisors meet to discuss ways to increase TCM referrals.
Working with agencies to develop new TCM resources for clients
Supervisor reviews a list of current TCM resources and makes changes as needed.
Development of a logic model for the TCM program
TCM – Program Planning and Policy Development (PPPD)
May be performed by SMC case managers if staff spent in designing or developing a specific program or projects, including health coalition work. Also time spent for in-service training, professional development activity or orientation, or providing training

21. 29. TCM Data Systems and Claiming Coordination
Review of all the Medi-Cal data submitted by the TCM service provider. This includes validation of the invoices submitted to DHCS.
Done by LGA coordinator and support staff. Cannot be a case manager

22. 28. Encounter Entry into TCM On-Line System
TCM service provider entry of encounter into the TCM on-line system from the encounter logs.
Persimmony does this for us

23. 31. TCM Subcontract Administration
Establishing subcontracts with CBOs to have them perform TCM.

24. Activities that are not TCM
23. Non-Targeted Case Management
2. Direct Patient Care
1. Other Programs and Activities
21. General Administration
22. Paid Time Off

25. 23. Non-Targeted Case Management
Example: Case management services for clients in the Lead program.
Time spent providing or supporting case management services to clients that do not meet the definition of TCM target populations.
Case management performed in other programs.
This does not apply to the majority of our PHN department. This code is currently used for case managers doing lead case management and AIDS program.
San Mateo County: Lead program, Asthma, CHDP, CCS, Dads Program, BIH

26. Not TCM 2. Direct Patient Care
Use when performing standard, routine work that is part of patient/client health care services
Counseling, patient education, patient instruction
Medical care and procedures, diagnostic & treatment services
Not TCM
Weighing infants. Medication reconciliation. Instruction regarding medications. Instruction regarding discharge instructions.
TCM – Direct Patient Care
Time spent providing education or direct patient care

27. 2. Direct Patient Care Examples of direct patient care:
Performing a focused assessment on a specific medical condition
Administering medication
Giving results of a test
Patient education on medications, preventative health issues, infant care
Direct clinical treatment - taking a blood pressure, weighing an infant
Weighing an infant: If just weighing the infant or providing an exam this is coded to direct patient care.
If a need was assessed during weighing (for example significant weight loss and breast feeding resource was provided- then it is code 24-providing TCM service component)
If weighing the infant while on hold for appointments then it is code 24-providing a TCM service component

28. 1. Other Programs and Activities
When to use the other programs and activities code
Use when performing activities which are:
NOT claimable under TCM
NOT claimable under direct patient care; usually billable to individuals or payable by a fiscal intermediary
NOT claimable under General Administration
Providing services that are not medical or Medi-Cal related including non-Medi-Cal health and wellness activities, social services, educational services, teaching services, employment and job training.
Example:
- Providing supportive counseling
TCM – Other Program Activities
Time spent providing supportive counseling (PAOT – Perinatal Alcohol and Other Drugs Team)

29. 21. General Administration
If any of the following pertain to TCM, code to TCM. Otherwise, code to General Administration
Preparing for, attending and participating in:
Staff meetings,
Committee meetings
In-service trainings
Orientations
Activities of being an employee that are not tasks performed for a specific program.
Talk meetings and how to pro-rate meetings. Meetings can be coded to multiple codes

30. 21. General Administration
Health promotion activities and events for county employees
General Non-TCM related supervision of staff (i.e. yearly performance reviews)
Site (office/facility) management and maintenance
Developing and monitoring budgets, not related to TCM
Reviewing professional/technical materials, not related to TCM
Ordering, typing, reception and other administrative duties, not related to TCM
Staff break time (Not Lunch)
Filling out a time sheet or mileage reimbursement
Filling out time survey at the end of the day

31. What General Administration is not
General Administration is not a “catch all” category
General Administration does not cover all s, phone calls, and paper work
What are the s and phone calls about? Are you following up with a referral? How about coordinating a meeting?
Is your paperwork prep for a meeting regarding TCM, public health nursing, or the health system? Are you providing nursing supervision or support to a case manager?
Not the whole meeting.
Not the whole training. What was the training about? A referral source – ask for examples. Skills you might need as a case manager – Motivational Interviewing – would be general administration.

32. 22. Paid Time Off Includes: Vacation Sick Leave Personal Time
Holiday Time
Any other employee time off that is paid
Jury duty, bereavement leave

33. Bad Practices Coding identical time each day
Employees doing same jobs coding significantly different
Time survey does not match time sheet
Insufficient documentation for those not doing perpetual time survey
Mention client documentation is supportive of time survey.

34. Best Practices Check time survey to payroll system for accuracy
Keep track daily of your TCM activities
Detailed documentation
Document same day

35. Three Days as a CM Tuesday Morning
Carl Case Manager arrives at the family resource center at 8 a.m. He has 3 referrals to follow up on. He spends the first two hours following up on 2 referrals. He provides one referral with some health education and sees if they were able to make their specialty appointment. At 10 a.m. Carl calls the third referral. Carl finds that this client would be appropriate to open to TCM. He spends 30 minutes speaking with the client and scheduling an appointment to do a home visit. He spends an additional half hour documenting on this new TCM referral.
Carl spends a total of 3 hours How should his time be coded?

36. Three Days as a CM
The two hours spent on CHDP work would be coded to the appropriate CHDP code. Persimmony in the background will crosswalk that time to code 1 – Other programs and activities. The hour spent speaking with the new TCM client and documenting on it would be coded to providing TCM Encounter-Related Activities (code 25).

37. Day 1 Continued Carl travels to home visit 11 a.m. to 11:15 a.m.
Carl does home visit assessment with postpartum and newborn with interpreter from 11:15 a.m. to 1 p.m.

38. Day 1 Continued
SLIDE 37

39. Day 1 Continued

40. Day 1 Continued Carl takes lunch from 1 p.m. to 1:30 p.m.
Carl documents home visit 1:30 p.m. to 2:30 p.m.
Carl spends 2:30 p.m. to 4:30 p.m. scheduling new home visits with clients, documenting on cases and coordinating care with a client’s social worker.
Lunch is not paid time. You do not code lunch.

41. Day 1 Continued

42. Day 1 Continued

43. Day 1
Total =
8 hours
Total hours should match what you put on your time sheet

44. Day 2 - Wednesday
8 a.m. - 9:30 a.m. - Carl is in the office. He is scheduled to meet with his supervisor to review his documentation and current case load.
9:30 a.m - 10 a.m. - Carl pulls referrals and makes calls to 4 clients to schedule home visits for today.

45. Day 2 continued

46. Day 2 continued

47. Day 2 continued
10 a.m. to 10:30 a.m. Carl drives to East Palo Alto for first home visit
10:30 a.m. to 11:15 a.m. Follow up home visit with newborn
Completed Newborn Referral form
Assessed infant. Made referral to Lactation consultant due to decreased weight.
Scheduled appointment at Ravenswood Health Center
Weigh the infant. Weight is fine. Would code to Direct Patient Care.
Weight Infant and significant weight loss, now making referral to lactation consultant. TCM

48. Day 2 continued

49. 12 noon to 12:30 p.m. Carl eats lunch at Chipotle
Day 2 continued
11:15 a.m. to 12 noon Follow up home visit with postpartum (mom)
Called WIC to schedule an appointment
Assessed client. Referral made to lactation consultant for sore nipples.
Family PACT passport completed with explanation of program and where to obtain services.
12 noon to 12:30 p.m. Carl eats lunch at Chipotle

50. Day 2 continued Ask – how is lunch coded?
Lunch is not paid time. Lunch is not coded.

51. Day 2 continued
12:30 p.m. to 12:45 p.m. Carl drives to Menlo Park for her next home visit
12:45 p.m. to 2:30 p.m. During Carl’s home visit he follows up on referrals that were previously made. He also does an ASQ, which identifies an additional need for the action plan.
What happens if Phoebe does an ASQ and finds the child all is well?
Time for ASQ is code 2 direct patient care.

52. Day 2 continued

53. Day 2 continued 2:30 p.m. to 2:45 p.m. Travel to next home visit
2:45 p.m. to 3:30 p.m. Carl sees the new TCM client he identified at the family resource center the day before.
What happens if Carl does an ASQ and finds the child all is well?
Time for ASQ is code 2 direct patient care.

54. Day 2 continued

55. Day 2 continued
3:30 p.m. to 4:30 p.m. Carl goes to Starbucks and documents his home visits. He also takes 10 minutes to completes his TCM Time study for Monday and Tuesday.

56. Day 2 continued

57. Day 2
Total = 8 hours

58. Day 3 - Thursday
8 a.m. to 9:30 a.m. Carl is in the office. He talks to the clerk who is having difficulty with a CCS authorization. They have a discussion with the supervisor regarding the problems with CCS.
Carl checks his s and a provider for information on his CCS referral.
9:30 a.m. to 10:30 a.m. Carl reads feedback from his supervisor and makes corrections to his charts.

59. Day 3 continued... 10:30 a.m. to 11:30 a.m.
Turn in referrals to clerical.
Complete mileage form.
Return calls to clients from messages on voice mail.
Discuss making phone calls to monolingual Spanish Speaking clients with CHW.
Call the interpreter/CHW to schedule home visits tomorrow.

60. Day 3 continued

61. Day 3 continued...
11:30 a.m. to 12 noon Meeting regarding client flow issues for services at the family resource centers

62. Day 3 continued

63. Day 3 continued... 12:30 p.m. to 1 p.m. Carl travels to home visit.
1 p.m. to 3:30 p.m. Carl does assessment home visit with mom and newborn twins.

64. Day 3 continued

65. Day 3 continued

66. Day 3 continued

67. 3:30 p.m. to 4:30 p.m. Completes documentation of home visits.
Day 3 continued...
3:30 p.m. to 4:30 p.m. Completes documentation of home visits.

68. Day 3 continued

69. Day 3
Total = 8 hours

70. Who wants to be a TCM millionaire
LET’S PLAY
Who wants to be a TCM millionaire

71. How should this time be coded?
Case Manager (CM) visits a high risk family with multiple problems. On Tuesday and Thursday the visits include follow-up on the TCM Care Plan and referrals made.
How should this time be coded?
(25) TCM Encounter- Related Activities
(21) General Administration
(24) Providing a TCM Service Component
(1) Other Programs and Activities

72. Charting and reading in preparation for home visits with Medi-Cal and non Medi-Cal clients who are being provided TCM services. How should this time be coded?
(24) Providing a TCM Service Component
(21) General Administration
(25) TCM Encounter –Related Activities
(1) Other Programs and Activities

73. Delivers a car seat to a new mother. How should this time be coded?
(1) Other Programs and Activities
(24) Providing a TCM Service Component
(25) TCM Encounter –Related Activities
(21) General Administration

74. CM does a home visit to a high risk family with multiple problems
CM does a home visit to a high risk family with multiple problems. The visit includes assessing the infant’s diaper rash, slow weight gain and making a referral to WIC. How should this time be coded?
(24) Providing a TCM Service Component
(2) Direct Patient Care
(25) TCM Encounter –Related Activities
(21) General Administration

75. CM takes 2 hours of sick leave to go to the dentist.
How should this time be coded?
(1) Other Programs and Activities
(2) Direct Patient Care
(22) Paid Time Off
(21) General Administration

76. CM consults with doctor’s office staff in preparation for conducting a home visit. How should this time be coded?
(24) Providing a TCM Service Component
(2) Direct Patient Care
(25) TCM Encounter –Related Activities
(21) General Administration

77. CM and translator visit a high risk infant.
Medical appointment is made, mom is provided a referral to a local support group, assists with applying for Medi-Cal, and child care education/instruction were provided. How should this time be coded?
(24) Providing a TCM Service Component
(2) Direct Patient Care
(25) TCM Encounter –Related Activities
(21) General Administration

78. How should this time be coded?
CM makes a home visit to deliver food and medication. Followed up on referral made to Food Bank.
How should this time be coded?
(24) Providing a TCM Service Component
(21) General Administration
(25) TCM Encounter –Related Activities
(1) Other Programs and Activities

79. How should this time be coded?.
During a home visit a CM performs an ASQ. The child’s scores do not warrant any referrals. The CM provides the client with some basic health education information.
How should this time be coded?.
(24) Providing a TCM Service Component
(21) General Administration
(25) TCM Encounter –Related Activities
(2) Direct Patient Care

80. How should this time be coded?
CM makes a home visit to assess a client’s response to newly prescribed antibiotics. Inquires about nutritional status, follows up medical appointments, and arranges transportation to new appointments.
How should this time be coded?
(24) Providing a TCM Service Component
(21) General Administration
(25) TCM Encounter –Related Activities
(2) Direct Patient Care

81. Staff is trained how to complete the MAA-TCM Time Survey.
How should this time be coded?
I would not code this time.
(21) General Administration
(25) TCM Encounter –Related Activities
(2) Direct Patient Care

82. A supervisor spends the morning reviewing a case manager’s documentation and providing feedback. How should this time be coded?
(27) Supervision of Case Managers
(21) General Administration
(30) TCM Quality Assurance/Performance Monitoring
(25) TCM Encounter –Related Activities

83. Complete and review time survey Staff complete and review time survey.
How should this time be coded?
(1) Other Programs and Activities
(21) General Administration
(30) TCM Quality Assurance/Performance Monitoring
(25) TCM Encounter –Related Activities

84. How should this time be coded? Complete and review time survey
At the request of the CM, the CHW arranges transportation to a pediatric clinic appointment.
How should this time be coded?
Complete and review time survey
(1) Other Programs and Activities
(21) General Administration
Have chw answer
(25) TCM Encounter –Related Activities
(2) Direct Patient Care

85. Complete and review time survey Staff took a 15 minute break.
How should this time be coded?
(1) Other Programs and Activities
(21) General Administration
Have chw answer
(2) Direct Patient Care
(22) Paid Time Off

86. How should this time be coded?
A case manager attends a meeting regarding TCM policies and procedures.
How should this time be coded?
(1) Other Programs and Activities
(21) General Administration
Have chw answer
(25)TCM Encounter – Related Activity
(2) Direct Patient Care

87. How does the CM code their visit and drive time?
A CM spends 30 minutes driving to a client’s house for a home visit. During the home visit the CM spends 30 minutes doing direct patient care and 30 minutes following up on needs on the action plan.
How does the CM code their visit and drive time?
(26)Travel Related to Providing TCM
(21) General Administration
Have chw answer
(24) Providing a TCM Service Component
(2) Direct Patient Care

88. How should this time be coded?
A CHW on behalf of the CM consults with a Medi-Cal provider to assure that services are available in Spanish.
How should this time be coded?
(26)Travel Related to Providing TCM
(21) General Administration
Have chw answer
(25) TCM Encounter – Related Activities
(2) Direct Patient Care

89. A CHW provides translation during a home visit to a TCM client.
How should this time be coded?
(1) Other Programs and Activities
(21) General Administration
Have chw answer
Code to whatever the CM codes to!
(25) TCM Encounter – Related Activities

90. A supervisor reviews and signs charts. How should this time be coded?
(32) TCM Program Planning and Policy Development
(27) Supervision of Case Managers
Have chw answer
(30) TCM Quality Assurance/Performance Monitoring
(21) General Administration

91. How should this time be coded?
A supervisor responds to s from their employee’s regarding their TCM cases.
How should this time be coded?
(32) TCM Program Planning and Policy Development
(27) Supervision of Case Managers
Have chw answer
(30) TCM Quality Assurance/Performance Monitoring
(21) General Administration

92. How should this time be coded?
CMs and CHWs discuss the need to provide more Spanish-speaking translators for TCM case managers.
How should this time be coded?
(1) Other Programs and Activities
(25) TCM Encounter-Related Activity
Have chw answer
(24) Providing a TCM Service Component
(21) General Administration

93. How should this time be coded?
CMs answer questions from referral sources regarding the appropriateness of a referral.
How should this time be coded?
(1) Other Programs and Activities
I wouldn’t code this time.
Have chw answer
(25) TCM Encounter – Related Activity
(21) General Administration

94. Program supervisors meet to discuss gaps in TCM service provision.
How should this time be coded?
(1) Other Programs and Activities
(32) TCM Program Planning and Policy Development
Have chw answer
(30) TCM Quality Assurance/Performance Monitoring
(21) General Administration

95. How should this time be coded?
A CHW develops a list of Cantonese speaking providers for TCM case managers.
How should this time be coded?
(25) TCM Encounter – Related Activity
(21) General Administration
Have chw answer
I would like to ask for a lifeline
(1) Other Programs and Activities

96. A supervisor oversees a CM who works in the AIDS waiver program.
How should this time be coded?
(23) Non-Targeted Case Management
(21) General Administration
Have chw answer
I would like to ask for a lifeline
(1) Other Programs and Activities

97. How should this time be coded?
A CHW has office time where they check Medi-Cal status on client’s, arrange home visits and follow up on referrals.
How should this time be coded?
(25) TCM Encounter – Related Activity
(2) Direct Patient Care
Have chw answer
(1) Other Programs and Activities
(21) General Administration

98. How should this time be coded?
While in the office a CHW prepares packets and sends out letters on behalf of the CMs.
How should this time be coded?
(1) Other Programs and Activities
(2) Direct Patient Care
Have chw answer
(25) TCM Encounter – Related Activity
(21) General Administration

99. How should this training be coded?
Staff attend a training about motivational interviewing arranged by their supervisors. They do not have to take approve CEU time for this training.
How should this training be coded?
(1) Other Programs and Activities
(2) Direct Patient Care
Have chw answer
(25) TCM Encounter – Related Activity
(21) General Administration

100. How should this time be coded?
Clerical staff access the State TCM system and check for TCM encounters that could be made claimable.
How should this time be coded?
(1) Other Programs and Activities
(28) Encounter Entry into the TCM on-line System
Have chw answer
(25) TCM Encounter – Related Activity
(21) General Administration

101. Questions?